Motor Control Retraining vs Close Kinetic Chain Exercises for Pain, Function and Vastus Medialis Oblique Strength in Patients With Patellofemoral Pain Syndrome

The visual analogue scale (VAS), a robust and trustworthy self-reported measure of pain, was used to gauge pain severity. The VAS is a 10-cm straight line, with "no pain" at one end and "worst pain" at the other. The participants were asked to mark the location that most accurately reflected the level of pain they were experiencing at the time. Greater pain severity was reflected by higher scores. With reported validity coefficients ranging from r = 0.71 to 0.78 and great reliability (ICC = 0.97), the visual analogue scale is a reliable and valid tool for measuring pain intensity.

The kujala anterior knee pain scale (AKPS), a disease-specific questionnaire intended to assess symptoms and functional limitations associated with patellofemoral diseases, was used to measure knee function. Thirteen elements make up the scale, which evaluates pain, limping, swelling, stair climbing, squatting, jogging, jumping, extended sitting, and other functional tasks. Better knee function and less complaints are indicated by higher scores, which range from 0 to 100. A highly valid and reliable tool for assessing symptoms and functional limitations related to patellofemoral diseases is the Kujala Anterior Knee Pain Scale (AKPS). It exhibits great test-retest reliability, greater internal consistency (Cronbach's α = 0.83-0.91), and strong validity (r = 0.90-0.92).

A hand-held dynamometer (Lafayette Instrument Model 01160) was used to evaluate the strength of the vastus medialis oblique (VMO) muscle. In standardized testing positions, participants executed maximal voluntary isometric contractions, and the force produced was measured. Stronger quadriceps and VMO muscles were indicated by higher values. A Hand-Held Dynamometer (HHD; Lafayette 01160) was used to measure the strength of the Vastus Medialis Oblique (VMO) muscle at 60° knee flexion. The HHD's application for assessing lower-extremity muscle strength is supported by its moderate to strong validity (r = 0.62-0.91) and acceptable to excellent reliability (ICC ≥ 0.70).

Kinovea 2D motion analysis software was used to measure dynamic knee valgus. Functional exercises like squatting, step-down chores, and single-leg movements were captured on video. Frontal-plane knee motion was measured and lower-limb alignment was examined using Kinovea software. Greater dynamic knee valgus was indicated by increased medial displacement of the knee during movement.

For evaluating lower-extremity kinematics and dynamic movement patterns, such as Dynamic Knee Valgus, Kinovea 2D Motion Analysis Software has shown great concurrent validity and excellent reliability (ICC = 0.916)

The q-angle was measured using a universal manual goniometer. An imagined line was drawn from the ASIS to the patella center, and another line was drawn from the patella center to the tibial tuberosity in order to calculate the angle. Increased lateral patellar tracking and modified patellofemoral biomechanics are linked to higher Q-angle values. A viable and trustworthy tool for determining the Q-angle is the manual goniometer. Good validity, greater intra-rater reliability (ICC = 0.88), and moderate to high inter-rater reliability (ICC = 0.77-0.85) have all been shown.

Dynamic knee valgus analysis and q-angle measurements were coupled to evaluate functional patellar maltracking. Instead of static anatomical malalignment, a normal Q-angle in the presence of severe dynamic knee valgus may suggest functional patellar maltracking because of changed lower-extremity movement patterns. This evaluation helped detect aberrant movement patterns causing anterior knee pain and shed light on the mechanics of the patellofemoral joint during functional activities A useful measure of lower-limb alignment during practical activities, functional patellar maltracking assessment using the combination of Normal Q-angle and High Frontal Plane Projection Angle (FPPA) has demonstrated acceptable to strong validity (r ≈ 0.64-0.78) and excellent reliability (ICC ≈ 0.88-0.89).